Pregnancy can be an exciting time in a woman’s life, and with it comes many health-related questions. For an obstetrics and gynecology (OB/GYN)doctor, it is also a unique time to develop relationships with patients and their loved ones. During regular prenatal visits, I have the opportunity to share in their joy, address concerns, and provide preventative care for the ultimate goal of a healthy mom and healthy baby.
Staying healthy begins with regular check-ups, with the first prenatal visit usually occurring around eight weeks. Sometimes women are seen earlier in their pregnancy, depending on their medical history or if they are experiencing symptoms such as bleeding or cramping. These symptoms can be concerning for a miscarriage, but can also occur in a normal pregnancy.
The first visit includes a review of past medical history, a physical exam, blood tests, and may include an ultrasound to confirm the due date. Patients return for check-ups at four week intervals initially, and visits become more frequent as their due date approaches.
Routine screening tests during pregnancy include a full screen for infection, a fetal anatomy ultrasound around 20 weeks, gestational diabetes screening at 24-28 weeks, and a culture for Group B streptococcus (GBS) at 36 weeks. There are also optional tests to screen for genetic abnormalities such as Down syndrome and risk of neural tube defects, which are discussed during prenatal visits.
In addition to regular check-ups, here is some other information about staying healthy during your pregnancy:
Nutrition: Prenatal vitamins with at least 400 micrograms of folic acid should be taken daily, ideally starting prior to pregnancy. Folic acid is a B vitamin critical for cell division and has been proven to decrease the incidence of neural tube defects such as spina bifida and anencephaly. Patients who are at higher risk for neural tube defects have higher requirements.
Fish and Fish Oil Supplements: There is evidence that omega 3 fatty acids are important for the developing fetal brain. These can be obtained by modifying your diet to include fish twice a week or taking fish oil supplements in the form of Docosahexaenoic acid (DHA) 200mg daily. Some prenatal vitamins already contain DHA. If you choose to eat fish twice a week, be sure to choose fish that is low in mercury.
Vitamin D/Calcium/Iron: Living in Seattle puts women at a higher risk of Vitamin D deficiency because of decreased sun exposure, especially in the winter months. Most prenatal vitamins contain 400 IU Vitamin D. Supplementations of 2,000-4,000 IU are generally thought to be safe and should be considered in addition to prenatal vitamins. We recommend that pregnant women get 1,000 mg of calcium each day. If you do not drink milk or eat other dairy products, take a 500 mg calcium supplement twice a day. Your physician will screen for anemia (low blood count) during pregnancy and may recommend iron supplements as well.
Weight Gain: Starting pregnancy at a healthy weight and gaining weight appropriately are important to avoid risks of gestational diabetes, large infant size, Cesarean-section delivery, and maternal weight retention after delivery. On the other hand, being underweight or not gaining enough weight during pregnancy increases the risk of having preterm birth and low birth-weight babies. The Institute of Medicine has established new guidelines recommending weight gain based on a woman’s body mass index (BMI) at the start of pregnancy. The average weight gain for a patient with a normal BMI should be 25 to 35 lbs.
Smoking: Smoking during pregnancy increases the risk of preterm labor and having a low birth-weight baby, so quitting is strongly recommended.
Nausea: Many women suffer from nausea and vomiting in early pregnancy, and this can make it difficult to get adequate nutrition. If you are struggling with nausea, try small meals throughout the day, eating crackers before you get out of bed, or a protein snack before bedtime. Try to find fluids that you can tolerate to help you stay hydrated. Fluids that are cold, carbonated, or acidic (such as lemonade) are sometimes better tolerated.
Vaccines: It is important for all pregnant women to get vaccinated with the flu vaccine during the flu season. Pregnant patients who get the flu are at high risk for severe complications, such as pneumonia and preterm labor. If you have flu-like symptoms such as fever, cough or sore throat, you should contact your doctor immediately. The other vaccine that is now recommended in pregnancy is the Tdap vaccine (pertussis or whooping cough vaccine) in the third trimester of every pregnancy. The vaccine gives important passive protection to your newborn baby.
Dr. Sue Moreni is a doctor of obstetrics and gynecology (OB/GYN) at the UW Neighborhood Clinic in Ravenna. For more information, call 206.520.5050 or visit uwmedicine.org/uwnc.